Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL |
NPI | 1003017849 |
---|---|
Provider Name | Heather Richelman |
First Address | Campbell Hill, IL 62916-2213 |
Second Address | Duquoin, IL 62832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |